What a year it has been for NHS reform. We’ve had Lord Darzi’s NHS Final Stage Review (‘changing the way we lead change’), the implementation of world class commissioning (whatever that is), the floating of an NHS constitution (embedding our values in law), the building of 150 polyclinics (preferably where they’ll do least damage), and the announcement that doctors are not only going to have to publish their outcomes, but will be paid according to how good they are. Oh, and Sir Liam Donaldson has announced annual competence checks for GPs. How can you take on board all these changes without your head exploding?
Clearly what we all need are some guidelines on how to implement change, and the NHS Institute for Innovation and Improvement is sponsoring an NHS Change Management conference later in the year. Many of the GPs I know are more concerned with the change in their practice income with the loss of the minimum practice income guarantee and competition from pharmacies and the private sector. But I thought I might try to see the big picture and have booked my place to learn how to implement ‘sustainable change’.
Or at least that was my plan before I read the programme. The introduction was enough to tick half the boxes on my buzzword bingo card. I checked off ‘change champion’, ‘change initiative’, ‘change resistance’, ‘change fatigue, ‘key stakeholders’, and ‘tools and techniques’ before deciding I may suddenly be doing something else that day! But the doctor–manager divide can never narrow unless we speak the same language, and GPs just aren’t able to do it and keep a straight face.
In desperation, health minister Ben Bradshaw has announced that the Department of Health will be ‘hiring private companies to help practice-based commissioning consortiums put together business cases that PCTs can understand’.1 They will apparently establish, at taxpayer’s expense, ‘a framework contract providing access to quality assured development support’ to aid a mutual understanding of those ‘service redesign bids’.
Clearly, you need the market jargon for your bid to pass muster with the PCT, but even if doctors could be taught the language, an even bigger barrier may be the values that underlie the tender process. Many doctors vehemently oppose the idea of health as a commodity, and are unlikely to be reassured by an NHS constitution. In the same week that the idea was floated, my local mental health trust advertised for an Executive Medical Director/Director of Strategy & Business Development to ‘drive the business development strategy in line with the business proposition, scanning the mental health environment for new opportunities and identifying and stimulating new business solutions that fit with the corporate vision.’ There’s plenty more in that vein but it makes me ill to read it.
Market forces are turning healthcare from a vocation into a money-making opportunity. It wouldn’t be so bad if there was evidence that they worked, but there isn’t. We do know, from America, that healthcare markets burn up money, duplicate services to create choice, and make profits for shareholders.
I don’t want doctors and nurses to learn the language of the market or to be offered bribes to practice good care. And I certainly don’t want us to ‘scan the mental health environment for new opportunities’. Why not just care for the mentally ill? Even better, prevent us becoming mentally ill by uniting around compassion, community, and happiness rather than ‘profitability’ (which the ad mentions four times)!
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